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1

Major applications of the Bio-psycho-social model.

• The promotion and maintenance of health

• The prevention and treatment of illness

• The identification of etiological and diagnostic correlates of health, illness, and related dysfunction

• The analysis and improvement of health care system and health policy formation

2

Importance of psychological knowledge for physicians

• Improves diagnosis, intervention and treatment outcomes

• Improves relationships with pts

• Improves adherence

• Equips physician to recognize and manage psychosocial symptoms

         o Pts rate higher quality of care when Drs work with pts            o 1/3 have mental disorders o 1/3 have psycho-social                   problems

3

attribution of symptoms

- People seek attributions (causal explanations) for illnesses

- The search for a cause is initiated so as to understand, predict, and control the threat posed by the illness

4

Misinterpreting symptoms compromises health

- Delay in seeking treatment

- Over or underuse of healthcare services

- Inappropriate self-treatment

- Poor adherence

5

Example of attribution error "majority of miscarriages are due to chromosomal abnormalities"

Mother’s emotional state (74%)

having a shock or fright during pregnancy (76%)

heavy lifting during pregnancy (64%)

STD’s in the mother (41%)

Previous abortion (31%)

Not wanting the pregnancy (25%)

6

Sick role

When a person attributes his/her symptoms to a “sickness,” he/she might assume the “sick role”

- Specifically patterned social role of “being sick”

- Contains customary rights and obligations based on social norms

7

Belloc & Breslow´s Seven Health Factors for Longevity

1. Sleep 7 to 8 hours

2. No eating between meals

3. Eat breakfast regularly

4. Maintain proper weight

5. Regular exercise

6. Moderate or no use of alcohol

7. No smoking

8

Health Belief Model Jeffrey Hochbaum, Irwin Rosenstock

The likelihood that someone would take action to prevent illness depends on his/her perception that:

1. He/she is vulnerable to the condition

2. The consequences of the condition would be serious

3. The precautionary behavior effectively prevents the condition

4. The benefits of reducing the threat of the condition exceed the costs for taking actions

9

Social Cognitive Theory (SCT)
Bandura, 1977
 

  • Health behaviors are influenced by the interplay of personal, environment, and social factors
  • Most behaviors are learned responses that can be modified
  • To change health behavior, one must learn cognitive and behavioral skills 

10

Social Cognitive Theory (SCT)
Bandura, 1977
 

11

Health Belief Model Jeffrey Hochbaum, Irwin Rosenstock

12

Social Cognitive Theory 

Personal Factors that influence behavior 

Bandura, 1977

•Personal characteristics 

•Emotional Arousal/Coping

•Behavioral Capacity

•Self-Efficacy*

•Expectations

•Expectancies

•Self-Regulation

•Observational/experiential learning •Reinforcement

13

Self-Efficacy

•The confidence one has in his/her ability to successfully carry out a behavior

•Influenced by 4 sources of information:

 –persuasion by others

– observing others’ behavior

–previous experience with performing the behavior

–direct physiological feedback 

14

Social Cognitive Theory 

Environmental Factors that influence behavior 

 

•Can be physical, social, cultural, economical, political, situational 

- one’s perceptions of the environment

15

Theory of Reasoned Action & Planned Behavior (TPB/TRA )
Icek Azjen, Marten Fisbhein

rational choice theory

•Two underlying assumptions: 

1)behavior is under volitional control

2)people are rational beings

 

We behave in a certain way because we choose to do so.  We use a rational decision-making process in choosing and planning our actions. 

 

16

Intention

(TRA/TPB)

 

•Intention - the decision to perform the behavior.

•The likelihood that an individual will engage in a health risk reduction depends on:

-how much he is convinced that health behaviors will prevent risk

-the degree to which he/she perceives that the benefits outweigh the costs.

17

Self-Determination Theory 

•Humanistic theory of motivation and well-being

•Central premise is that individuals have innate tendencies toward personal growth and vitality that are either satisfied or thwarted by their immediate environment

•The optimal conditions for promoting motivation and well being are those that meet psychological needs for competence, relatedness, and autonomy 

18

Intrinsic motivation 

Behavior that is energized by the pleasure derived from engaging in the activity itself

19

Extrinsic motivation

Behavior that is energized by external contingencies such as attaining reward, avoiding threats, gaining recognition, or conforming to some prevailing value.

20

Applying SDT to Healthcare

Autonomy

Competence

Relatedness

•Autonomy – most health-related behaviors aren’t inherently enjoyable, so if they are to be successfully initiated and maintained, the patient must value them and personally endorse their importance •

•Competence – the patient needs skills and tools for change, as well as recognition and support for competent behaviors •

•Relatedness – mutual trust and respect promotes internalization, openness to information, and compliance with recommendation 

21

Trans-theoretical Model of Behavior Change (TTM)

•Describes change as a process, not an event

•People change incrementally in stages, and they do not move linearly from stage to stage

(typically they progress and then recycle back to previous stage before moving forward again)

22

Common Sense Model of self-regulation (CSM)

Model of the cognitive and affective mechanisms underlying chronic illness management

•People develop “common sense” understandings of their illness or diagnosis called illness representations

•People select treatment based on common sense match between perceived cause of illness and treatment perceived as most likely to address it

•People respond to illness representation with action planning/coping  

•People compare coping strategies to expected outcome (appraisal), evaluate, and then make changes to representations and strategies as needed